Mucosal lichen planus

Mucosal lichen planus' is a chronic inflammatory condition of the mucous membranes, often affecting the oral and genital regions. It is a subtype of lichen planus, a disease that can affect the skin, hair, nails, and mucous membranes. Mucosal lichen planus primarily involves the mucosa, presenting unique challenges in diagnosis and management.

Symptoms and Signs

The symptoms of mucosal lichen planus can vary depending on the affected area but commonly include:

• Oral lichen planus: White, lacy patches on the gums, tongue, or inside the cheeks, often accompanied by burning sensations or soreness. Erosive oral lichen planus, a more severe form, can cause painful ulcers and erosions.
• Genital lichen planus: In women, it may cause redness, erosions, and soreness of the vulva. In men, it can affect the glans penis, leading to similar symptoms.
• Esophageal lichen planus: Although rare, it can cause dysphagia (difficulty swallowing) and esophageal strictures.

Causes and Risk Factors

The exact cause of mucosal lichen planus is unknown, but it is believed to be an autoimmune condition where the immune system attacks the mucous membrane cells. Risk factors may include genetic predisposition, presence of other autoimmune diseases, and certain triggers such as infections or medications.

Diagnosis

Diagnosis of mucosal lichen planus involves a thorough clinical examination and history taking. Biopsy of the affected mucosa is often necessary to confirm the diagnosis and rule out other conditions such as candidiasis or squamous cell carcinoma. Direct immunofluorescence may also be used to distinguish it from other similar conditions.

Treatment

Treatment of mucosal lichen planus aims to reduce symptoms and prevent complications. Options include:

• Topical corticosteroids: The mainstay of treatment for reducing inflammation and pain.
• Systemic treatments: For severe cases, systemic corticosteroids, immunosuppressants, or biologic agents may be considered.
• Symptomatic treatments: Such as pain relievers and mouthwashes for oral hygiene.
• Laser therapy: For resistant cases, especially in erosive oral lichen planus.

Prognosis

Mucosal lichen planus is a chronic condition that can have periods of remission and flare-ups. While it is not curable, symptoms can often be managed effectively with treatment. Regular monitoring is necessary to check for potential complications, including the rare but possible transformation into squamous cell carcinoma, particularly in erosive forms.

Prevention

There is no known prevention for mucosal lichen planus, but avoiding triggers, maintaining good oral hygiene, and regular dental check-ups can help manage the condition and reduce the risk of complications.